Provider Demographics
NPI:1407001100
Name:MARTIN, BARBARA WARNER (PHD)
Entity Type:Individual
Prefix:DR
First Name:BARBARA
Middle Name:WARNER
Last Name:MARTIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:VICKSBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39183-2913
Mailing Address - Country:US
Mailing Address - Phone:601-634-0118
Mailing Address - Fax:
Practice Address - Street 1:1121 GROVE ST
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-2913
Practice Address - Country:US
Practice Address - Phone:601-634-0118
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS48 832103TC0700X
AL948103TC0700X
GAPSY002327103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical